Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Vesikel <1 cm
Bula >1 cm
Penonjolan kulit berisi nanah
Pustula
Kista
Skuama pengelupasan kulit yang berlebihan
Diskontinuitas jaringan
Krusta cairan yang mengering / kerak / keropeng
STI –symptomatic approach
Duh Tubuh Duh Tubuh Bubo
Ulkus Kutil Kelamin
Uretra Vagina Inguinalis
Candidiasis Limfogranulo
vaginitis ma venereum
STI –symptomatic approach
Duh Tubuh Duh Tubuh Bubo
Ulkus Kutil Kelamin
Uretra Vagina Inguinalis
Candidiasis Limfogranulo
vaginitis ma venereum
Duh Tubuh Vagina
• GO
CERVICITIS* • NON-GO
• TRIKOMONIASIS
VAGINITIS • BAKTERIAL VAGINOSIS
• CANDIDIASIS VAGINITIS
Kuning-hijau, Putih-kuning
Putih-abu
berbuih bergumpal
Whiff/amine test
Strawberry cervix Gatal, radang
(+)
*
Wanita
Disseminata
Cervicitis GO
Herpes
genitalis
Uretritis GO Chancroid
Cervicitis NGO
Trichomoniasis
Uretritis NGO LGV
Ulkus Durum
(Sifilis)
Candidiasis
Ulkus Genital
Secondary Syphilis
Secondary Syphilis–
Condylomata Lata
Syphilis: Workup
Indirect test: Serology
• Nontreponemal test: (untuk screening dan evaluasi)
• Venereal Disease Research Laboratory (VDRL)
• Rapid Plasma Reagin (RPR)
• Treponemal test: (untuk konfirmasi)
• T. Pallidum hemagglutination (TPHA)
• Fluorescent treponemal antibody-absorption (FTA-ABS)
• Quantitative VDRL/RPR
• Microhemagglutination assay T. Pallidum (MHA-TP)
• Treponemal enzym immunoassay (EIA) IgG, IgM
Cervicitis GO
Ulkus Durum
(Sifilis)
Uretritis GO LGV
Cervicitis NGO
Trichomoniasis
Uretritis NGO Chancroid
Herpes
genitalis
Candidiasis
Bubo Inguinal
• Bubo ingunalis dan femoralis: pembesaran
kelenjar getah bening setempat di daerah
pangkal paha disertai rasa sangat nyeri, dan
fluktuasi kelenjar.
• DD:
– ULKUS (-) Limfogranuloma venereum
– ULKUS (+) Lihat ULKUS GENITAL
Limfogranuloma Venereum
• Kausa:
Chlamydia trachomatis
• Inkubasi: 5-20 hari
Signs of groove
• Gejala:
– Vesikel pada penis/vagina
transien jarang disadari
– 2-6 minggu setelah vesikel
hilang bubo inguinal
radang (+), sangat nyeri
– Demam, menggigil
Pedoman Nasional IMS, Kemenkes, 2011
Resume Bubo Inguinal
BUBO BUBO
INGUINAL INGUINAL
(+) (-)
ULKUS Chancroid/ Granuloma
(+) Chancre/ Inguinal/
Herpes Donovanosis
Genital
ULKUS LGV -
(-)
STI –symptomatic approach
Duh Tubuh Duh Tubuh Bubo
Ulkus Kutil Kelamin
Uretra Vagina Inguinalis
Cervicitis GO
Ulkus Durum
(Sifilis)
Uretritis GO Chancroid
Cervicitis NGO
Trichomoniasis
Uretritis NGO LGV
Herpes
genitalis
Candidiasis
GENITAL
HPV WARTS
Warts(Condyloma Accuminata)
on the Thigh
• Kausa: HPV
• Massa seperti bunga kol
• Tes acetowhite
Tx:
Asiklovir 5x200 mg
Valasiklovir 2 x 500 mg
VZV –Varicella (Chicken Pox)
Lesi polimorfik (makula, papula,
vesikel, krusta)
Lesi muncul dari wajah badan
ekstremitas
Terapi: - Asiklovir 5x800
- Valasiklovir 3x1000
Hutchinson’s sign
precedes the development
of ophthalmic herpes
zooster
Ramsay Hunt Syndrome
VZV Infection of the head and neck that
involves the facial nerve, often the CN VII,
but might also CN VIII, IX, V, VI
Ganglion
geniculatum
Might be observed:
(CN VII)
• VZV auricularis
• VZV in any zoster zones of the head
and neck (herpes auricularis, herpes
facialis, herpes occipitocollaris) with
facial palsy
• VZV in any of the zoster zones with
facial palsy and auditory symptoms
(tinnitus, deafness, vertigo,
nystagmus, ataxia)
Terapi: amitriptilin 100 mg, nortriptilin 25 mg,
gabapentin 300 mg, capsaicine/lidocaine patch
Molluscum Contagiosum
(Condyloma subcutaneum)
• Kausa: Molluscum contagiosum virus (Pox virus)
• Badan Moluskum atau Henderson-Paterson bodies
Nyeri (+)
Furuncle & Carbuncle
Furuncle Carbuncle
This lesion represents multiple confluent
furuncles draining pus from multiple openings
Furunculosis
Terapi Pioderma
• Lokal
– Banyak pus/krusta: kompress dengan PK 1/5000, rivanol 3x sehari
@1jam selama keadaan akut
– Tidak tertutup pus/krusta: krim mupirosin 2% atau asam fusidat 2% 2x
sehari selama 7-10 hari
• Sistemik (5-7 hari)
– Kloksasilin atau dikloksasilin
• 4x250-500 mg (dewasa); 50 mg/kg/hari dalam 4 dosis (anak)
– Amoxiclav
• 3x250-500 mg (dewasa); 25 mg/kg/hari dalam 3 dosis (anak)
– Eritromisin
• 4x250-500mg (dewasa); 20-50 mg/kg/hari dalam 4 dosis
• Insisi dan drainase
– Khusus karbunkel yang menjadi abses
Skin and soft tissue infection
CLUE:
• Superfisial Batas TEGAS , merah terang
• GABHS
• Wajah, tungkai
Treatment:
• penicillin PO or IV for 5 days
• Cold compress
• Elevation and rest
Selulitis
CLUE:
• Deeper (subkutan)
Batas TIDAK TEGAS
• Keterlibatan deep
lymphatic vessels (+)
• S. aureus/GABHS
• Tungkai
Treatment:
• penicillin PO or IV for 5 days
• Cold compress
• Elevation and rest
Phlegmon
• Selulitis dengan supurasi (undrainable)
• Acute diffuse purulent inflammation of the adipose
tissue, may continue to muscles and tendons
Treatment:
• penicillin PO or IV for 5 days
• Cold compress
• Elevation and rest
Tx Skin and soft tissue infection
Bacillus anthracis
• Bakteri gram positif, aerob, parasit obligat
Wood’s lamp
PVC - Tx
Dermatofitosis
(Tinea--)
CLUE:
• Trichophyton, epidermophyton,
microsporum
• Tepi aktif, central healing
• KOH: hifa panjang bersekat. TIDAK
ADA ragi
Tinea cruris
“Black dot” tinea capitis
Tinea Infection with fractures of the hair leaving the
infected dark stubs visible in the follicular orifices
Capitis
Kerion
heavily crusted, hairless plaque Tinea capitis “gray patch”
Heals with scarring and permanent A large, round hyperkeratotic plaque of alopecia due
alopecia to breaking off of hair shafts close to the surface.
Most common in
Exothrix Endothrix
• Perkembangan • Adanya
arthrocodinia di perkembangan
bagian eksterior ahtrocodinia
batang rambut. hanya di dalam
Kutikula rambut batang rambut
hancur kuning kronis.
kehijauan di Kutikula rambut
bawah sinar intak dan tes
lampu Wood lampu Wood (-)
• Paparan hewan • Black dot
peliharaan
• Gray patch
Pull test
• Hair-pull test gives a rough estimate of how much hair is being lost. It is
done by grasping a small portion of hair and gently applying traction while
sliding the fingers along the hair shafts. Usually one to two hairs are
removed with this technique. The hairs are then examined under a
microscope
Tinea manuum
Griseofulvin TINEA
• Dosis: 1x500mg atau 2x250mg
• Utk tinea PEDIS dan ONYCHOMYCOSIS 2x500mg atau 4x250mg.
• Lama terapi tergantung jenis
• 2 to 4 weeks for tinea barbae, tinea corporis, and tinea cruris
• 4 to 6 weeks for tinea capitis
• 4 to 8 weeks for tinea pedis
• 4 months for onychomycosis of the fingernail
• 6 months for onychomycosis of the toenail.
Nystatin CANDIDIASIS
• Drop oral thrush
• Suppositoria candidiasis vaginal, apalagi ibu hamil
• Tablet Esophagus & GIT. Langsung bekerja on site, tdk diserap sistemik
• Untuk Candidiasis Cutis lokal berikan Ketoconazole, Miconazole, atau Clotrimazole topical
Ketoconazole
• Ketokonazol: 200 mg/hari (10 hari)
• Itrakonazol: 200 mg/hari (7 hari) PVC, 100 mg/ hari (10-14 hari) Tinea
Keywords
PVC Tinea Candidiasis
Malassezia furfur Trichophyon, Candida Albicans
Epidermophyton,
Microsporum
Makula-patch, skuama Tepi aktif, central healing Area lipatan, lesi satelit
halus Finger nail sign (+)
Fluoresensi Diagnosis
Fluoresensi merah bata Eritrasma
Skabies
Pedikulosis
Ptiriasis
Pediculosis Corporis
TERAPI
Pediculosis Pubis • Medikamentosa:
• First line: Permethrin cream 1% 2 jam
• Alternative: Malathion 0.5% lotion semalam
Gameksan 1% 12 jam
• Nonmedikamentosa:
• Cuci dengan air hangat. Lice and eggs are
killed by exposure for 5 minutes to
temperatures >53.5°C
Pediculosis Capitis
Cutaneus Larva Migrans
( creeping’s eruption)
• Larva Ancylostoma
braziliensis
• Treatment:
– Albendazole 1x400
mg (3d) OR
– Ivermektin 2x6mg
– Topical
corticosteroid
– Use liquid nitrogen
cryotherapy for
progressive end of larval
burrow
TB Chancre
Exogeneous
TB Verucosa Cutis
(Direct inoculation
(TVC)
into the skin)
Lupus Vulgaris
(LV)
Cutaneous TB Scrofuloderma
Contiguous
Infection Orificial TB
TB Milier Akut
Endogenous
Metastatic TB
Hematogenous
Abscess
Lupus Vulgaris
(LV)
Lupus Vulgaris
Lymphogenous
(LV)
TB Chancre
• Primary inoculation TB
typically follows a
penetrating injury that
results in the direct
introduction of
mycobacterium into
the skin or mucosa of
an individual with no
previous TB
infection.
• Papul shallow firm
nonhealing nontender
ulcer
TB verukosa
• direct inoculation of TB into
the skin of people who were
previously infected.
• a painless, solitary, purplish or
brownish-red warty plaque
that may extend peripherally
causing central atrophy or
form fissures that exude pus
or keratinous material.
• Hiperkeratosis (verrucous)
• Knees, elbows, hands, feet
• may persist for years but can
clear up even without
treatment
TB verukosa
Lupus Vulgaris
• Chronic and progressive form of CTB that
is widely described as the most common
form of CTB with a multitude of
presentations.
• Lesions occur in normal skin as a result of
direct extension from underlying deeper
TB focus, by lymphatic or hematogenous
spread, after primary inoculation, after
BCG vaccination, or in scars of old
scrofuloderma.
• small, solitary, nodular, sharply defined,
reddish-brown lesions with a gelatinous
consistency (called apple-jelly nodules) on
the head and neck, lower extremities or
buttocks
• persist for years, leading to disfigurement
and sometimes skin cancer
Scrofuloderma
• direct extension of
underlying TB
infection of
lymph nodes,
bone or joints.
• Anak & dewasa
muda
• Kronik, sering
kambuh
• Nodul supurasi
ulkus tepi
ireguler
Orificial TB
• Advanced TB
• Imun jelek
• Autoinokulasi
• Ulkus bergaung,
eritem, purulen,
hemoragik
TB milier –kulit
• Chronic TB infection that has
spread from the primary
infection (usually in the
lungs) to other organs and
tissues via the bloodstream
• Immunocompromised:
HIV/AIDS, cancer, bayi/anak
• Poor prognosis
• Small, erythematous to
violaceous papules or
pustules with hemorrhagic
necrosis and umbilication
affecting a substantial
portion of the body
Metastatic TB Abscess
(TB Gumma)
• can arise from breakdown
of an old healed tubercle
that still contains live
organisms or from cell-
mediated immune defense
inhibition that reactivates
• malnourished children and
immunosuppressed adults
• nontender, fluctuant
nodules develop forming
draining sinus abscesses
“Metastatic abscess” unless surgically incised
and drained
s
Miliaria profunda
Lepra
Multiple nodules, Multiple plaques,
xerotic skin leonine face
Multiple Multiple
erythematous anesthetic ulcers
nodules, painful
Klasifikasi Lepra menurut WHO
Clinical features Paucibacillary (PB) Multibacillary (MB)
Lucio Phenomenon
Reaksi kusta ringan tx: prednison
Alergi Immunologi
Erythema Multiforme
Urticaria
Urticaria
• Akut: <6 weeks ?
• Terapi:
– Antihistamin H1
• Bila gagal ganti/ naikkan dosis/ kombinasi
– Kortikosteroid, indikasi
• Angioedema (+)
• Refractory effect of antiH1
Jenis-jenis antihistamin
Cold Urticaria: ice cube test
Exanthematous
Drug Eruption
Farmakoterapi
• Kortikosteroid sistemik:
Prednison 3x10 mg/hari (1
minggu)
• Antihistamin sistemik:
Obat pencetus: antibiotik, NSAID
– Setirizin2x10 mg/hari (7
Reaksi hipersensitivitas tipe IV hari) k/p
– Loratadin 10 mg/hari (7
Erupsi makulopapular hari) k/p
eritematosa tersebar • Topikal:
morbiliformis, simetris – Bedak salisilat 2% dan
antipruritus (Menthol 0.5%
Predileksi: Tungkai, lipat paha, - 1%)
dan lipat ketiak
Fixed Drug Eruption
Reexposure obat lesi pada tempat yan
sama.
Obat pencetus: Sulfonamid, Barbiturat,
Trimetoprim, dan analgetik
Reaksi hipersensitivitas tipe II
Lesi khas:
• Vesikel, bercak eritema
• Lesi target,bentuk bulat lonjong atau
numular , adang disertai erosi
• Bercak hiperpigmentasi dengan kemerahan
di tepinya, terutama pada lesi berulang
Newborn, children
(almost all <6yo), adult
with chronic disease
Etiology: Staphylococcus
Immune reaction for
exotoxin (exfoliatin)
Management:
Hospitalization
Antibiotics (dikloksasilin)
Dermatitis Dermatitis
Dermatitis atopi
Kontak Iritan Kontak Alergi
Pengobatan pemeliharaan
• Setelah fase akut teratasi, max 4 minggu
• Kortikosteroid topikal q24h
• Krim pelembab q12h
DKI vs DKA
Acute allergic contact dermatitis due to nickel. This papular erythematous eruption with vesiculation and
crusting occurred at the site of contact with the clasp of a watch band. Contact hypersensitivity to nickel
was verified by patch testing.
DKA
Patch test
Dilakukan minimal 2 minggu setelah dermatitis
mereda, pada bagian tubuh yang tidak memiliki
riwayat terpapar dermatitis
Indikasi:
• DKA idiopatik
• Dermatitis yang tidak sembuh dalam waktu singkat/persisten
• Penggunaan terapi topikal kronis
DKI Kumulatif
• Kontak berulang pada iritan lemah (ex:deterjen)
• Predileksi ditangan
Dermatitis kontak iritan akut: • Kelainan muncul dalam hitungan minggu, bulan
• iritan kuat (H2SO4 atau HCl) bahkan tahun
• Lesi: eritem, edema, bula kadang nekrosis
• Tepi berbatas tegas
TOXIC IRRITANT CONTACT DERMATITIS
ec insect bite
Treatment :
• Topical steroids in the mid to high
potency
• Oral antihistamines are useful if
pruritus is severe
• Oral antibiotics are indicated
when secondary infection is
present
Stasis Dermatitis
Most common in lower legs
SS :
Doksisiklin50-100 mg 2x sehari
Lentigo Simplex
• Most common, appears at birth or early childhood
• Small dark papule distributed widely including in mucosa and
conjunctiva
• Consider syndrome association when numerous an/or involve mucosa
Solar Lentigo
• Age spots / liver spots / actinic lentigine
• Sun exposed areas
• Benign, not associated with any medical conditions, risk for skin cancer
Freckles
Basal cell carcinoma: rodent-ulcer type. A large ulcer filled with black necrosis
and hemorrhagic crusts is surrounded by a well-demarcated rolled border
consisting of typical nodules of a BCC (translucency, teleangiectasia). It has
destroyed almost the entire cheek.
Squamous Cell Carcinoma